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Health Inspection

Fair Oaks Lodge

March 11, 2026 · Wadena, MN · 201 Shady Lane Drive
Citations 4
CMS Rating 2/5
Beds 65
Provider ID 245581
Healthcare Facility
Fair Oaks Lodge
Wadena, MN  ·  View full profile →
Inspection Summary

Fair Oaks Lodge in WADENA, MN — inspection on March 11, 2026.

Found 4 citations. Severity: Standard violations.

Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.

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Inspection Findings

FF0554
Resident Rights Deficiencies

During a follow-up interview on 3/11/26 at 8:41 a.m., DON

During an interview on 3/11/26 at 12:30 p.m., pharmacist consultant (PC) verified medications were not to be left in a resident's room without an assessment done and an order from the primary care provider to ensure a resident is able to administer medications safely.

A policy titled medication self Administration, revised on 2/12/24, identified: the resident shall have a screen completed by a licensed nurse to determine factors that impact the self administration of medications.

The ability to self-administer medications will indicated, able to self-administer medications independently, able to self-administer medications with supervision, cueing, and/or set-up, not able to self-administer medications safely.

Residents who have been deemed appropriate to self-administer medications independently or with supervision/, cueing and/or after setup, shall have a physician's order to do so.

The self-administration of medications will be care planned with interventions specific to the individual resident.

Medications to be self-administered shall be secured in a locked are in the resident's room or stored in the medication cart for provision to the resident to self-administer.

245581 03/11/2026

Fair Oaks Lodge 201 Shady Lane Drive Wadena, MN 56482

Review of R47's EMR failed to indicate a restraint assessment was completed to ensure seat belt was not considered a restraint for R47, in addition, R47's EMR lacked a physician order for seat belt use when in power wheelchair. R47's care plan did not address seat belt use when in power wheelchair.

When interviewed on 3/10/26, at 3:20 p.m. NA-A stated R47 used a seat belt when in the power wheelchair, R47 was able to remove it independently but had difficulty applying the seat belt due to limited use of one arm.

When interviewed on 3/10/26, at 3:23 p.m. trained medication assistant (TMA)-A stated R47 was unable to apply the seat belt, had use of one hand but R47 was able to remove the seat belt independently.

When interviewed on 3/11/26 at 10:52 a.m., DON stated when a resident utilized a seat belt in the wheelchair the expectation was there would be an order from the physician and a restraint assessment to ensure the resident was able to apply and remove the seat belt independently to ensure it would not be considered a restraint. DON reviewed R47's EMR stated there was no physician order, no documentation regarding an assessment was completed. DON stated the therapy recommendation to use the seat belt in the power wheelchair should have triggered the assessment to completed and the physician order to be obtained.

Facility restraint policy was requested; however, none was received.

245581 03/11/2026

Fair Oaks Lodge 201 Shady Lane Drive Wadena, MN 56482

During observation on 3/9/26 at 1:00 P.M., the staff posting for Friday March 6th was observed in the facility.

During interview with Administrator on 03/09/2026 3:49 P.M. confirmed that staff list posted in the facility was wrong date.

Administrator confirmed that posted list should be updated but that the person who posted it daily was gone out for the day.

She confirmed that she should have updated the staffing A facility policy titled Staff Posting revised 10/19/23 indicated the facility shall post daily, for each shift, the actual hours and total number of hours worked by licensed and unlicensed nursing staff who are directly responsible for resident care on each shift in the facility. At the beginning of each shift, the facility will verify that the hours are posted in a clear and readable format: the name of the facility, current date, facility census for nursing home residents, facility specific shifts for the 24-hour period, total number of licensed nursing staff worked per shift, total number of unlicensed nursing staff worked per shift, actual time worked for the specific categories of nursing staff, including split shifts.

and trained medication aides (TMAs). DON stated narcotics/controlled medications that included

have a locked medication fridge. DON stated without the locked fridge the lorazepam was not secured

room door being left open with no nurse/TMA in the room or in direct eyesight. DON stated it was important to secure the medication room and narcotic/controlled medications for safety and to decrease risk of diversion by a resident or an unauthorized staff member.

When interviewed on 3/11/26, at 12:30 p.m. consultant pharmacist (CP) stated doors to medications were expected to be shut and locked if nurse/TMA is not inside the room or in direct view of the room. CP stated lorazepam was required to be in medication fridge with either a locked fridge door or a secured lock box located inside the fridge for safety, decrease diversion. CP stated medication room doors left open was an unacceptable process.

Facility Medication Storage policy revision date of 2/12/24, indicated compartments containing medications should be locked when not in use.

Medications that required refrigeration should be stored in the refrigerator.

All controlled drugs are stored under double-lock and key.

245581 03/11/2026

Fair Oaks Lodge 201 Shady Lane Drive Wadena, MN 56482

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in WADENA, MN, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from Fair Oaks Lodge or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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